Interval between neoadjuvant treatment and definitive surgery in locally advanced rectal cancer: impact on response and oncologic outcomes
Interval between neoadjuvant treatment and definitive surgery in locally advanced rectal cancer: impact on response and oncologic outcomes
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DOI：
10.1007/s00432-014-1718-z
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发表时间：
2014-10-01
影响因子：
3.6
通讯作者：
Sole, Claudio
中科院分区：
文献类型：
--
作者：
Calvo, Felipe A.;Morillo, Virginia;Sole, Claudio
局部进展期直肠癌（LARC）新辅助治疗完成与手术之间的最佳等待时间存在争议。本研究的具体目的是评估延长这一时间间隔对病理反应，术后发病率和长期肿瘤outcomes.Retrospective数据分析的影响，从LARC患者谁已接受放化疗，然后手术和术中放疗，1995年2月至2012年12月。根据新辅助治疗和手术之间的时间，总共研究了两组：常规间隔（CI; < 6周）和延迟间隔（DI;每千日元6周）。比较了与肿瘤反应、术后发病率和肿瘤学结局相关的临床病理学数据。DI组中临床分期淋巴结受累（cN+）的患者比例较高（76.6 vs. 64.1%; p = 0.01）。病理学完全缓解（pCR）在组间无显著差异（8.8 vs. 12.1%; p = 0.34）。更长的间隔时间并不影响并发症的发生率或严重程度或住院时间。DI组的某些新辅助治疗后肿瘤效应参数显著增加，包括N分期降低和T缩小。中位随访71个月后，DI组患者的5年总生存率（OS）高于其他组（上级）（55.9 vs. 70.4%，p = 0.014）;然而，在5年无病生存期（DFS）或5年局部控制（LC）方面未观察到统计学显著差异（分别为69.9 vs. 74.9%，p = 0.223; 90.4 vs. 94.5%，p = 0.123）。适度的手术间隔延迟（每千日元6周的部分）不会增加术后并发症，并被确定为OS的有利预后因素，尽管在pCR、LC或DFS方面没有观察到差异。可以安全地探索创新的多学科策略，包括进一步延长手术间隔时间。
The optimal waiting period between neoadjuvant treatment completion and surgery in locally advanced rectal cancer (LARC) is controversial. The specific purpose of this study was to evaluate the effect of prolonging this interval on the pathologic response, postoperative morbidity, and long-term oncologic outcomes.Retrospective data analysis is reported from LARC patients who had been treated with chemoradiation followed by surgery and intra-operative radiotherapy, between February 1995 and December 2012. In total, two groups were studied, according to the time elapsed between neoadjuvant treatment and surgery: conventional interval (CI; < 6 weeks) and delayed interval (DI; a parts per thousand yen6 weeks). Clinicopathological data related to tumor response, postoperative morbidity, and oncologic outcomes were compared.This study included 335 consecutive LARC patients. There was a higher proportion of patients with clinical staging nodal involvement (cN+) in the DI group (76.6 vs. 64.1 %; p = 0.01). The pathologic complete response (pCR) was not significantly different among groups (8.8 vs. 12.1 %; p = 0.34). Longer intervals did not affect complication incidence or severity or hospital admission length. Certain postneoadjuvant tumor effect parameters were significantly increased in the DI group, including N-downstaging and T-downsizing. After a median follow-up of 71 months, patients in the DI group presented with superior 5-year overall survival (OS) (55.9 vs. 70.4 %, p = 0.014); however, no statistically significant differences were observed in 5-year disease-free survival (DFS) or 5-year local control (LC) (69.9 vs. 74.9 %, p = 0.223; 90.4 vs. 94.5 %, p = 0.123, respectively).A modest surgical interval delay (a parts per thousand yen6 weeks) did not increase postoperative complications and was identified as a favorable prognostic factor for OS, although no differences were observed in pCR, LC, or DFS. Innovative multidisciplinary strategies incorporating further time extension of the surgical interval can be safely explored.